儿童单侧脑瘫的手功能发育。
Hand use development in children with unilateral cerebral palsy.
机构信息
Department of Neurosciences in Children, Cerebral Palsy Follow-up Program (CPOP), Oslo University Hospital, Oslo, Norway.
Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway.
出版信息
Dev Med Child Neurol. 2021 Dec;63(12):1462-1468. doi: 10.1111/dmcn.14957. Epub 2021 Jun 21.
AIM
To describe the development of hand use during bimanual activities among children with unilateral cerebral palsy (CP).
METHOD
A cohort of 166 children (79 females, 87 males; age range 18mo-13y, mean [SD] age at first assessment 37.6mo [20.5mo]) with unilateral CP, registered in the Norwegian CP Follow-up Program with two or more Assisting Hand Assessments (AHAs), were included in this longitudinal study comprising 524 AHAs. Developmental limits and rates were estimated by non-linear mixed effects models and compared between a stable limit model (SLM) and a peak and decline model. Development was described according to Manual Ability Classification System (MACS) levels and AHA performance at 18 months of age (AHA-18).
RESULTS
Children in MACS level I, or in the high AHA-18 group, reached highest limits and had the most rapid development (p<0.001). The developmental trajectories were different between MACS levels I, II, and III and between the high, moderate, and low AHA-18 groups. Seventy-five per cent of the children reached 90% of their estimated limit at 5 years 10 months or earlier. The SLM showed the best model fit (Akaike information criterion: 4008.99).
INTERPRETATION
Most children approached a steady performance limit before 6 years of age. Although children in MACS levels I and II reached 90% of the expected limit at 3 and 4 years respectively, the corresponding age was 8 years for children in MACS level III. The better model fit for the SLM indicates that children with unilateral CP maintain their attained limit of hand use to at least the age of 13 years. What this paper adds Development of hand use between 18 months and 13 years follows a stable-limit pattern. Most children reach a steady limit on the Assisting Hand Assessment before 6 years of age. Manual Ability Classification System levels I, II, and III represent distinct developmental trajectories, level III having a slower rise. Early hand use is an important indicator of future development.
目的
描述单侧脑瘫儿童在双手活动中手使用的发展情况。
方法
本纵向研究纳入了挪威脑瘫随访计划中注册的 166 名儿童（79 名女性，87 名男性；年龄 18 个月至 13 岁，首次评估时的平均[SD]年龄为 37.6 个月[20.5 个月]），这些儿童具有双侧脑瘫，且具有两次或以上的辅助手评估（AHA）。本研究包含 524 次 AHA，使用非线性混合效应模型来估计发展限制和速度，并在稳定极限模型（SLM）和峰值和下降模型之间进行比较。根据手能力分类系统（MACS）水平和 18 个月时的 AHA 表现（AHA-18）描述发展情况。
结果
MACS 水平 I 或 AHA-18 高组的儿童达到了最高的限制，且发展速度最快（p<0.001）。MACS 水平 I、II 和 III 之间以及 AHA-18 高、中、低组之间的发展轨迹不同。75%的儿童在 5 岁 10 个月或更早达到其估计限制的 90%。SLM 显示出最佳的模型拟合度（赤池信息量准则：4008.99）。
解释
大多数儿童在 6 岁之前达到了稳定的表现极限。虽然 MACS 水平 I 和 II 的儿童分别在 3 岁和 4 岁达到了预期限制的 90%，但 MACS 水平 III 的儿童达到该限制的相应年龄为 8 岁。SLM 的更好的模型拟合度表明，单侧脑瘫儿童至少在 13 岁之前保持其获得的手使用极限。本文的新增内容：18 个月至 13 岁期间手使用的发展遵循稳定极限模式。大多数儿童在 6 岁之前达到 AHA 的稳定极限。手能力分类系统水平 I、II 和 III 代表不同的发展轨迹，水平 III 的上升速度较慢。早期手的使用是未来发展的重要指标。
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